Individual
TIFFANY ANN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
13609 CALIFORNIA ST, OMAHA, NE 68154-5260
(402) 891-1118
Mailing address
PO BOX 173, LYONS, NE 68038-0173
(402) 380-8468
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1058
NE
Other
Enumeration date
04/05/2012
Last updated
04/05/2012
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